tbuckley/cabot-search huggingface dataset:
Does adherence to cancer prevention guidelines before diagnosis associate with improved cancer survival?
Authors: Evan W. Davis, Nisha M. Nair, Karen Hulme, Nancy Barone, Christine B. Ambrosone, Rikki A. Cannioto
Journal: Journal of Clinical Oncology (2023)

10582 Background: The American Institute for Cancer Research and American Cancer Society regularly publish cancer prevention recommendations for decreasing cancer risk. Which lifestyles, or whether they work together to impact cancer survival is not well established. We examined associations of adherence to cancer prevention recommendations with mortality in 5,766 patients enrolled in the Data Bank and BioRepository at Roswell Park. Methods: Patients were newly diagnosed between 2003 and 2016 with a variety of pathologically confirmed invasive malignancies. Detailed epidemiological data including lifestyles one year prior to diagnosis were linked with Tumor Registry data. The primary analytic exposure was a composite Lifestyle Index Score (LIS) created in accordance with previously published standardization guidance; the primary analytic outcome was all-cause mortality. The LIS comprised seven lifestyles including: physical activity (PA); body mass index (BMI); fruit and vegetable (FV) intake; red and processed meat (RPM) intake; sugar sweetened beverage (SSB) consumption; alcohol consumption; and smoking status. Kaplan Meier analyses were used to compare survival experience according to LIS tertiles. Multivariable Cox proportional hazard models adjusted for age, tumor type, stage, and sex were used to estimate the associations of the LIS and each lifestyle factor with mortality in the overall study population and according to tumor stage. Results: During follow-up through April 2022, we observed 2,316 deaths (median follow-up 6.9 years). Patients reporting strongest adherence to prevention recommendations (highest LIS tertile) had significantly improved survival compared to patients with the lowest LIS (93.0 vs. 75.0 months, respectively; log-rank p &lt; 0.0001). In multivariable analyses, the highest versus lowest LIS tertile was associated with a 17% reduction in mortality in the overall study population (HR = 0.83, 95% CI: 0.74-0.93). Significant mortality reductions were observed in patients diagnosed with both early- and late-stage disease (HR = 0.73, 95% CI: 0.59-0.90 and HR = 0.85, 95% CI: 0.73-0.99, respectively). Being a never smoker (HR = 0.54, 95% CI: 0.47-0.62), meeting the PA Guidelines (HR = 0.74, 95% CI: 0.66-0.83), and highest FV intake (HR = 0.82, 95% CI: 0.73-0.91) were the only independent factors associated with significant reductions in mortality. Conclusions: Strongest adherence to the cancer prevention recommendations before diagnosis was associated with significant reductions in mortality. These findings provide additional evidence that modifiable lifestyle factors can impact cancer survival, even among patients diagnosed with advanced-stage disease. Confirmatory studies examining post-diagnosis lifestyles are needed so that lifestyle assessment tools, education, and intervention can be clinically leveraged to improve patient outcomes.
Trends in mortality caused by neoplasms of the heart in the United States between 2000 and 2019: An observational analysis of disparities by gender and race.
Authors: Abhishek Shahapurkar, Housam Alhariri, Chinmay Jani, Sarju Ganatra
Journal: Journal of Clinical Oncology (2023)

10532 Background: Neoplasms of the heart, primary and metastatic, are relatively rare diseases in the US. Metastatic neoplasms are 30 times more common than primary neoplasms and constitute more than 99.3% of the total neoplasms of the heart. Only a few studies have evaluated the mortality trends of this rare disease. Therefore, we aim to analyze the trends of mortality caused by benign and malignant neoplasms of the heart from 2000-2019 and compare them based on gender and race. Methods: We utilized the CDC WONDER database to extract data on Heart Benign Neoplasms (ICD 10 D15.1), Heart Malignant Neoplasms (C38.0), and overlapping lesions of Heart, Mediastinum, and pleura (C38.8) mortality in the United States between 2000 to 2019. ICD codes were applied to multiple causes of death. Age-standardized mortality rates (ASMR) per 1,000,000 with a 95% confidence interval were presented for the total population, stratified by gender and race. We assessed the mortality trends using joinpoint trend analysis. Results: From 2000 to 2019, 3493 deaths were reported due to neoplasms of the heart, out of which 1672 (47.86%) were due to benign neoplasms, and 1821 (52.13%) were due to malignant neoplasms. Overall, total deaths and ASMR decreased from 221 to 139 and 0.82 to 0.35, respectively, with an Average Annual Percentage change (AAPC) of -3.5. Out of 3493, the majority were females (2254, 64.5%). On evaluating ASMR based on gender, it decreased from 0.65 to 0.32 (AAPC -2.6) for males and from 0.89 to 0.35 for females (AAPC -3.9). On dividing based on racial subgroups, 2962 deaths were in whites, 413 were in African Americans (AA), and 118 were from other races (Asian, Pacific Islanders, Native Indians). On further comparison between Whites and AA, ASMR was found to be higher in AA throughout the study period. For AA, ASMR decreased from 1.18 to 0.51 (AAPC -4.9), and for Whites, from 0.76 to 0.33 (AAPC -2.5). Conclusions: This study has shown a decline in overall mortality trends across genders and races. This could be attributed to increased cardiac workups for cardiovascular conditions and advances in imaging modalities, cardiac oncology, and therapeutic interventions. Although the mortality trend in females is decreasing, they still have higher mortality rates than males. At the same time, although AA showed a higher rate of reduction in ASMR, they showed an overall higher ASMR throughout the study period. Further studies are needed to assess if increased screening, early detection, and management plans are causing a decrease in overall mortality in neoplasms of the heart. [Table: see text]
Outcome differences by sex in oncology clinical trials.
Authors: Ashwin V. Kammula, Alejandro A. Schaffer, Padma Sheila Rajagopal, Razelle Kurzrock, Eytan Ruppin
Journal: Journal of Clinical Oncology (2023)

e18808 Background: NIH guidance advises clinical trials to analyze participants by sex to improve inclusivity. We performed a systematic analysis of reported differences in outcomes between males and females in a registry of oncology clinical trials to characterize treatment response differences more broadly by sex for future trials. Methods: We analyzed Trialtrove ( https://citeline.informa.com/trials/results ), a trial repository using over 58,000 sources, to search for oncology trials that compared outcomes in male and female participants. We implemented algorithms using Python3 programs to search for all trials that contained terms regarding sex in the context of terms suggesting comparison or outcome and considered these as candidate comparison trials. Candidate trials were manually curated to record comparisons by sex across cancer type, treatment, outcome measure, “similar” or “different” by sex and evidence. Outcomes were classified as either “survival / response / other outcome” (SRO) or side effects (E). Evidence for each comparison was labeled as statistically significant (multivariate or univariate), having non-significant numerical evidence, or having no numerical evidence. We counted only those trials in which all comparisons by sex were consistent. Results: 472 of 89,221 oncology trials in Trialtrove (data freeze 12/23/22) (0.5%) performed 532 post-treatment comparisons by sex. Among 288 trials that did statistical SRO comparisons, 47 (16%) trials reported that males showed better, statistically significant treatment responses, while 122 (42%) trials reported better results for females. We observed the strongest differences by sex for two disease-treatment pairs: EGFR inhibitors (EGFRi) in non-small cell lung cancer (NSCLC) and rituximab in non-Hodgkin’s lymphoma (NHL). In 82 trials with SRO comparisons in NSCLC, 35 (43%) showed better treatment responses in females, and 13 (16%) showed better treatment responses in males. Among the 36 NSCLC trials using EGFRi, 21 (58%) showed better treatment responses in females, versus only 1 (3%) in males. In contrast, among all 46 other NSCLC trials with SRO comparisons, 14 (30%) favored females and 12 (26%) favored males. These results suggest that EGFRi may have treatment-specific benefits in females with NSCLC. Among 33 trials with SRO comparisons in NHL, 20 (61%) showed better treatment response in females, versus only 4 (12%) in males. 13 of these trials used rituximab, among which 10 (77%) favor females and only 1 (8%) favors males. Better response in females to rituximab has been reported in single trials but not characterized in aggregate. Conclusions: Our search identified two clinically important disease-treatment pairs that showed markedly improved outcomes in females versus males. Better understanding of differences in treatment response by sex across clinical trials is needed, both to improve inclusivity and as a basis for potential future combination treatments.
Awareness and perceptions of clinical trials in patients with cancer and their families in Turkey.
Authors: Pinar Kubilay, Cihan Erol, Seda Kahraman, Seher Yildiz Tacar, Erkan Özcan, Fatma Bugdayci Basal, Fatih Köse, Mehmet Ali Nahit Sendur, Deniz Tural, Irfan Cicin, Berna Oksuzoglu, Yüksel Ürün
Journal: Journal of Clinical Oncology (2023)

e18780 Background: Patient preference plays an important role in enrolling in clinical trials. We conducted this study to understand the perceptions knowledge and willingness of cancer patients or their families about clinical trials. Methods: A questionnaire in Turkish language was conducted including the sociodemographic characteristics of the participants and the factors that may affect their decision to participate in clinical trials. The study was carried out in 5 tertiary health care institutions with clinical research centers in Turkey. Adult patients diagnosed with solid tumors or their family members who agreed to participate were surveyed by medical doctors. Participants were interviewed between January 2020 and April 2021. Comparisons between groups were carried out using chi-square test χ2 for the categorical variables. IBM SPSS25 was used in analyses and p&lt;0.05 was accepted as the level of significance. Results: A total of 978 patients whose age ranged 18 and 82 (Mean= 51.43, SD=14.41) participated in the study. %50.3 was male, %40.7 was female. Willingness to participate a clinical trial was positively corelated with participants self reported health condition is excellent or good (p=0.206), well knowledge about clinical trials (p&lt;0.001), high school or higher education level (p&lt;0.001), household income above poverty level (p=0.003), previously received systemic cancer treatment of himself or family member or friend (p=0.03). %73.7 stated they are more willing to participate if their oncology specialist conducting the clinical trial. %84.3 want to get information about the clinical trial from their oncology specialist. %72.5 stated that positive experiences of a previous clinical trial participant will affect their decision making. Top corcerns about clinical trials are possible treatment side effects (%56.7), being treated as a test subject (%29), risk of placebo (%20.1). Top motivations are accessing best doctors (%45.8), accessing newest and best treatment options (%40.7), getting more information about their health condition (%68.9), helping science adventions (%82.6). Conclusions: Even when patients are eligible for a clinical trial physicians may somehow not discuss the clinical trial option. For patients oncology specialists are a highly trusted source of information and can play an important role in raising awareness and encouraging participation. [Table: see text] [Table: see text]
Psychosocial health of patients engaging in medical aid in dying and their family members: A prospective descriptive analysis.
Authors: Chloe Turner, Jonathan Singer, Courtney Daum, Katie P Himes, Lauren Elliott, Darcie Caldwell, Laura Lavell, Anne A Armstrong, James Hnida, Jourdan Cruz, Elizabeth Trice Loggers
Journal: Journal of Clinical Oncology (2023)

12032 Background: Medical Aid in Dying (MAID) allows patients (pts) with a terminal illness and less than 6 months prognosis to request a prescription that will end their life. MAID is controversial; opponents argue that negative psychological health underlies the choice, and that participation adversely effects pts and FMs. This is the first study to prospectively examine psychological health of pts and Family Members (FMs) who engaged in MAID and compare this to the psychological health of pts and FMs who did not utilize MAID. Methods: Pts and FMs were recruited prospectively from End-of-Life Washington (largest non-profit, public MAID advocacy/assistance organization in Washington State) from September 2022-January 2023 to a self-report, longitudinal study. Pts, FMs or the dyad were enrolled. Results of this study are compared to previously published results: *means (standard deviation, SD) taken from *Singer, et al. 2021; **Frikkel, et al. 2021; ^Robinson, et al. 2016 and ~Trevino, et al. 2013. + indicates no significant difference between MAID and non-MAID subjects at p &gt; .05 level. Results: 16% (8/51) of eligible pts and 49% (20/41) of eligible FMs were recruited. 55% (n = 11) of FMs were spouses. There was no difference in sex and subjects were mostly white (pts 87.5%; FMs 95%) with college or higher degrees (pts 62.5%; FMs 85%). Most pts reported having cancer (n = 6 [75%]; neurologic condition, n = 1 [12.5%]; cirrhosis, n = 1 [12.5%]); most FMs also reported their pt had cancer (n = 17 [85%]; neurologic condition, n = 3 [15%]). There were no differences in psychological health between terminal cancer pts and FMs who engaged in MAID and advanced cancer pts &amp; FMs who did not (see table). Conclusions: In this study, FMs and pts participating in MAID appear to have rates of negative psychological states that are in the low to moderate range. These rates appear similar to pts with advanced cancer and their FMs who are not engaging in MAID. Future research should study larger, heterogeneous populations earlier in the illness trajectory. [Table: see text]
Rates of colorectal cancer screening versus lung cancer screening: Where does the problem lie?
Authors: Sasmith R. Menakuru, Ahmed Salih, Vijaypal S. Dhillon, Nasser H. Hanna
Journal: Journal of Clinical Oncology (2023)

e22504 Background: In 2021, the U.S. Preventive Services Task Force recommended expanding the population who should undergo routine lung or colorectal cancer screening to include those between 50 and 80, with a 20-pack or more smoking history, and those who are currently smoking or have quit within the last 15 years. According to the Centers for Disease Control, 74.3% of the at-risk population undergo colorectal cancer screening. In contrast, according to the American Lung Association, only 5.8% of the eligible population undergoes lung cancer screening. Methods: This is a retrospective analysis of 158 patients who underwent colorectal cancer screening by colonoscopy between July 2022 and October 2022 at a high-volume hospital in Indiana. Patients were followed up in their primary care office between November 2022 and January 2023 to assess if they had also met the screening criteria for lung cancer with a low dose computed tomography (LDCT) scan. Patients who met the lung screening criteria were interviewed at their subsequent primary care appointment to evaluate their knowledge, attitudes, and compliance with lung cancer screening. Results: Of the 158 participants, 86 (54.4%) met the criteria for lung cancer screening with a LDCT. Only 5 (5.8%) of the eligible subjects underwent LDCT screening. 72 of the 81 patients who were not screened for lung cancer had scheduled follow-ups with their primary care provider during the study time frame. Of these 72 patients, 45 (62.5%) lacked knowledge about LDCT and lung cancer screening, despite meeting the criteria for it. 22 (30.5%) did not think they needed a LDCT, and 5 (6.9%) had no interest in screening despite previous awareness. All 72 patients who had colorectal cancer screening but not lung cancer screening were asked why they underwent the former but not the latter. 68 (94.4%) indicated that colonoscopy was recommended to them and that they knew someone in their families who had it done. Conclusions: Colon cancer screening rates remain high compared to lung cancer screening rates in an at-risk population. A lack of knowledge from patients is the primary reason for not receiving LDCT, despite receiving colon cancer screening.
Vitamin D deficiency as a risk factor for breast cancer development.
Authors: James David Mackey, Peter Young, Rene Zimmerer, Brittany Miles
Journal: Journal of Clinical Oncology (2023)

10559 Background: Previous studies and meta-analyses have suggested that women with low levels of vitamin D may be at increased risk of breast cancer development and recurrence. The relationship is suspected to be inverse, nonlinear, and predominantly present in postmenopausal women. The purpose of this study was to use the TriNetX platform to determine the magnitude of breast cancer risk increase for women with significant vitamin D deficiency and evaluate the significance of menopause on vitamin D-associated breast cancer risk. Methods: The TriNetX platform was used to generate patient cohorts via International Classification of Disease-10 (ICD-10) codes. All patients were females over 40, had no prior history of breast cancer (C50), and had been diagnosed with menopause (Z78.0). One cohort had less than 20 ng/mL of vitamin D while the other had greater than 30 ng/mL. The cohorts were balanced for age, race, and ethnicity, resulting in 73,659 patients in each arm. They were then evaluated for the future development of breast cancer (C50). Two additional cohorts were created of premenopausal patients aged 40-55 using the same vitamin D parameters and cohort balancing. Results: Postmenopausal women with vitamin D levels below 20 ng/mL had a 45% greater risk of developing breast cancer (risk ratio 1.45, 95% CI (1.38,1.52), p-value &lt;0.0001). (Table) Deficient premenopausal women were also found to be at significantly increased risk although the absolute risk difference was small (relative risk 1.18, 95% CI (1.10,1.27), p-value &lt;0.0001). Conclusions: These results confirm and also quantify the previously-suspected increased breast cancer risk for women who are deficient in vitamin D. The impact of low vitamin D levels on breast cancer risk in premenopausal patients was statistically significant but small in magnitude, while postmenopausal women were found to have approximately 45% higher risk as compared to women who were not deficient. Vitamin D supplementation for all deficient postmenopausal women should be considered. [Table: see text]
Impact of occupational therapy on comprehensive care in pediatric oncology.
Authors: Hui-Yun Hsueh
Journal: Journal of Clinical Oncology (2023)

e22018 Background: Children with cancer can experience difficulties in performing and engaging in their usual activities and the families can also experience interruptions to their daily routines as well as family dynamics. Yet, current cancer rehabilitation tends to focus more on the aspect of bodily repair and functional restoration. This study intends to illustrate the impact of occupational therapy approaches that were identified to have positive influence on the children with cancer and their family. Methods: Three cases of children with brain tumor of age 1, 4 and 16 were reviewed and their caregivers were interviewed. Family education on disease progression, caregiver burden, unhealthy caregiving style, and activity participation facilitation, and coping strategies for the teenaged survivor were included in the regular occupational therapy sessions. Results: Of the three cases, two families of the younger clients who later deceased, reported being supported with the occupational therapy service from emotional support to facilitating activity participation. The other case was reported to have resumed activity participation both in the hospital and at home following a client-centered occupational therapy approach. Conclusions: Although it is important to facilitate functional restoration or preservation, it does not facilitate activity participation on children with cancer if psychological and/or contextual factors are not taken into consideration. It is equally important to meet children’s developmental needs and educate their caregiver/family to provide the proper care they need. Coping is required for both child survivor and their caregiver/family. Client-centered approach that is used in occupational therapy can provide comprehensive care to both children and their family in meeting the needs of the child and family and facilitating activity participation.
COVID-19 and prevalence of venous thromboembolism among cancer patients: A nationwide inpatient sample analysis.
Authors: Muhammad Bilal Ibrahim, Rafaella Litvin, Hiba Noor, Ali Husnain Khan, Michelle Ishaya, Khaldun Obeidat, Philip Onyekaoso Kanemo, Ayobami Gbenga Olafimihan, Ekrem Turk, Badri Aryal, Muhammad Tayyab Anwar, Aneeza Jamshed, Kunnal Batra
Journal: Journal of Clinical Oncology (2023)

e18839 Background: Cancer, as well as immunosuppression from chemotherapy, aggravates thromboembolism risk. The risk is likely amplified in an additive fashion with COVID-19 infection, which confers a higher risk of VTE risk with viral sepsis, endothelial inflammation, and microthrombi formation. Numerous studies have shown the heightened risk of pulmonary embolism among severe COVID-19 patients. We sought to evaluate further the extent of COVID-19-associated coagulopathy and associated outcomes. Methods: National Inpatient Sample 2020 was used to identify non-elective hospitalizations of patients with a secondary diagnosis of any cancer. These were stratified into two cohorts based on the presence of the primary diagnosis of COVID-19. Primary outcomes include venous thromboembolism, PE, and VTE without PE in cancer patients with and without Covid-19 infection. The secondary outcomes examined were in-patient mortality, the average length of stay (LOS), and total hospital charge (THC). Multivariate analysis was performed to obtain the odds ratio. All weighted analysis was conducted through STATA 17. Results: Out of 1,734,735 non-elective admissions of patients with cancer, 36,295 (2%) were admitted for COVID-19. Our analysis showed statistically non-significant increased odds of venous thromboembolism(aOR:1.09 CI 0.99-1.20) in cancer patients with COVID. There was, however, a significant increase in the odds of pulmonary embolism(aOR 1.7, CI: 1.51- 1.91) among cancer patients with Covid-19. There were decreased odds of VTE without PE(aOR: 0.67 CI: 0.57-0.78). There was a statistically significant increase in odds of mortality (aOR: 2.8 CI: 2.63-3.0), length of stay(aOR:1.85 CI: 1.65- 2.05), total hospital charges($83,201 vs. $78,869 p: &lt; 0.01) in cancer patients with COVID-19 compared to cancer patients without COVID-19. Conclusions: This study shows that COVID-19 in cancer patients has deleterious effects, including an increased risk of pulmonary embolism and poor in-hospital outcomes. The finding of a lower incidence of non-PE VTE in patients with cancer is likely related to limitations with coding in NIS, in which lower complexity codes might be omitted in patients with multiple diagnoses. With significantly increased mortality and economic burden, these findings emphasize the significance of thrombotic prophylaxis and vaccination in cancer patients. [Table: see text]